Abstracts

RATIONALE: Patients with psychogenic pseudoseizures (PP) frequently have affective disorders, anxiety disorders and personality disorders. The global psychological distress experienced by epilepsy patients with/without PP is apparent, yet the premorbid personality disorders in PP patients what significantly impair coping skills in stressful situations is not fully understood. It is possible that certain Personality Disorder Clusters described in the DSM- IV could be used as a predictive factor for the diagnosis and prognosis of PP. Therefore we prospectively evaluated patients who were diagnosed with epilepsy in adulthood admitted for video EEG monitoring for psychiatric symptomatology.
METHODS: The psychiatric profiles of three groups of patients i.e. patients with epilepsy, patients with pseudoseizures only and patients with both epilepsy and pseudoseizures were assessed using the Symptoms Checklist- 104 and the Structured Clinical Interview for DSM IV Axis II Personality Disorders.
RESULTS: Eleven patients who were admitted with a preliminary diagnosis of epilepsy and/or pseudoseizures were included in this study. All subjects were female with a mean age of 40.6 years. Subjects by seizure group include Group1 (patients with epilepsy and PP) n=6, Group 2 (patients with PP only) n=3 and Group 3 (patients with epilepsy) n=2.
All ten subgroups of symptoms assessed by the SCL-104 (including somatization, obsessive-compulsive symptoms, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, psychotic, and dissociative symptoms) did not show any statistically significance between the three groups. Amongst the patients with PP (with or without epilepsy) 4 had cluster B Personality Disorders (Borderline PD, Histrionic PD, Antisocial PD, and Narcisstic PD) 2 had Cluster C Personality Disorder (Avoidant, Dependant, Obsessive Compulsive PD), 1 had no Personality Disorder, 1 patient refused and 1 patient was not able to complete testing. Patients with epilepsy only had no Personality Disorder.
CONCLUSIONS: These results suggest that patients with epilepsy, PP or both have multiple psychiatric symptoms that cause global suffering. Our preliminary results suggest that in patients with PP there is a high prevalence of PD (particularly Cluster B and C), which imply persistent maladaptive coping mechanisms that need special attention as predictors of PP diagnosis and treatment.